the european rheumatology curriculum ......european rheumatology curriculum final version. 31st...

European Board of Rheumatology (a Section of UEMS)

THE EUROPEAN RHEUMATOLOGYCURRICULUM FRAMEWORK

Contents

Background................................................................................... 1

Aims ............................................................................................ 2

Competency framework –The Physician Roles ................................... 3Medical Expert Role................................................................. 5Communicator Role................................................................. 15Collaborator Role .................................................................... 20Manager Role ......................................................................... 24Health Advocate Role .............................................................. 28Scholar Role........................................................................... 32Professional Role .................................................................... 36

List of conditions............................................................................ 41

European Rheumatology Curriculum

Final version. 31st January 2008 1/47

BACKGROUND

The European Board of Rheumatology (http://www.uems-rheumatology.net/) is the re-

presentative body of rheumatologists within UEMS (Union Européenne des

Médecins Spécialistes). One of its statutory purposes is the formulation of a

common policy in the field of training aiming at the highest standards of

rheumatological medical care throughout Europe. Members of the UEMS Section

of Rheumatology are appointed by the appropriate professional organizations of

the specialties in the EC member states and EFTA countries in accordance with

UEMS rules of procedure.

The Board has recently published recommendations on what a rheumatology ser-

vice should be expected to offer in order to provide appropriate healthcare for

patients with musculoskeletal conditions1. The Charter for Rheumatology training

in the EU, was also revised and approved in December 20062.

This document takes the process one step further towards the harmonization of

rheumatology specialist training within the European Union, by providing a refer-

ence framework to the development and benchmarking of National Curricula for

the Specialist Training of Rheumatologists.

It represents a major revision of the UEMS Rheumatology Specialist Core Curricu-

lum produced in 2003. We adopted the CanMEDS 2005 Physician Competency

Framework3, (Copyright 2005-2007 The Royal College of Physicians and Surgeons

of Canada. Reproduced with permission). Other sources were the Core Curricu-

lum Outline for Rheumatology Fellowship Programs published by the American

College of Rheumatology4, and some European National Rheumatology Curricula5.

1Anthony D Woolf and The European Union of Medical Specialists Section of Rheumatology/European Board of

Rheumatology. Health Care Services for those with musculoskeletal conditions: a rheumatology service.Recommendations of the European Union of Medical Specialists Section of Rheumatology/European Board of

Rheumatology 2006. Ann Rheum Dis 2007;66:293–301.2

José A. P. Da Silva, Karen-Lisbeth Faarvang, Klaus Bandilla and Anthony D Woolf on behalf of the UEMSSection and Board of Rheumatology. UEMS charter on training of rheumatologists in Europe. Ann Rheum Dis2008. In Press.3

Frank, JR. (Ed). 2005. The CanMEDS 2005 physician competency framework. Better standards. Betterphysicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada.http://rcpsc.medical.org/canmeds/CanMEDS2005/CanMEDS2005_e.pdf4

American College of Rheumatology. Core Curriculum Outline for Rheumatology Fellowship Programs. ACompetency-Based Guide to Curriculum Development. http://www.rheumatology.org/educ/training/CCO.pdf



Expert educational input was provided by Professor Reg Dennick, Assistant Direc-

tor of the Medical Education Department of the University of Nottingham, UK.

The content of this document was consensually adopted through discussions and

consultations with the representatives of all member countries in the UEMS Board

of Rheumatology6 and participation of the Permanent Working Group of Junior

Physicians of the EU.

It should be considered in conjunction with European Board of Rheumatology

Education Guide, which presents recommendation on how best to organize, deliv-

er and assess the curriculum while respecting national preferences.

AIMS

It is recognized that conditions and regulations under which medicine and rheu-

matology are practiced are extremely variable between different countries and

will remain so. Definition of medical curriculum aims, structure and contents re-

main under the exclusive domain of national authorities.

However, harmonization of specialist training in Europe is deemed essential to

guarantee standards of care and support freedom of movement of medical spe-

cialists among member countries. Guidelines on specialist training provide an im-

portant opportunity to increase quality standards on behalf of people with

musculoskeletal conditions.

The UEMS Board of Rheumatology does not hold either the intent nor the authori-

ty to impose a defined curriculum structure, content or aims to individual coun-

tries. This document aims solely to provide national authorities and professional

bodies involved in the development of curricula for the training of rheumatolo-

gists with a comprehensive reference framework of core competencies to be

achieved by the end of rheumatology specialised training in Europe. Trainees may

5The Danish, Curriculum for Specialist Training in Internal Medicine: Rheumatology. National Board of Health.

Danish Society for Rheumatology. January 2004. Edited in January 2005. The British, Specialty TrainingCurriculum For Rheumatology. Joint Royal Colleges of Physicians Training Board. May 2007 (http://www.uems-

rheumatology.net/ ; www.jrcptb.org.uk).6

Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece,Hungary, Iceland, Ireland, Italy, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia,Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom.



use it as a source of reference and benchmarking, for appreciation of their own

training standards and as source of inspiration to promote positive change where

appropriate.

Many different educational strategies can be adopted to achieve these competen-

cies. The choice of curriculum strategy will largely depend on national traditions

and resources. It was decided, therefore, to refrain from prescribing any specific

curriculum structure. However, it was felt that harmonization and quality promo-

tion could be served by a contextualized review of good practices in curriculum

planning and development. This has been compiled into a resource document ad-

dressing the qualities and limitations of different teaching and assessment me-

thods –the European Board of Rheumatology Educational Guide, provided as an

independent document (http://www.uems-rheumatology.net/).

COMPETENCY FRAMEWORK. THE PHYSICIAN’S ROLES

The Seven Roles of Physicians, as defined by the CanMeds framework, form the

structure for the organization of competencies. This was chosen in recognition of

its ability to encompass the complex and ever-evolving roles the physician is ex-

pected to play in present day medicine. It underlines the need to bring crucial but

previously ignored competencies, such as communication and professionalism, to

the forefront of medical training objectives. Such competencies need to be fully

recognized as central to the medical profession and can no longer be left to un-

checked individual determination.

Certainly, the role of Medical Expert will continue to deserve a central place in

medical education and training, but also the competencies of Communicator,

Collaborator, Manager, Health advocate, Scholar, and Professional should

to be clearly represented in educational programmes.

The CanMEDS framework was adopted because it also embodies the educational

move from the definition of objectives in terms of knowledge and skills to a defi-

nition based around competencies. Competencies are understood as the ability to

use knowledge, skills and appropriate attitudes to solve clinical problems in a pro-

fessional, ethical and proficient way for optimal patient and societal outcomes.



Each section starts with a short definition of the role and a more extensive de-

scription of its nature in the perspective of the Rheumatologist. This is followed

by a listing of key elements, which are meant to rise to consideration the diver-

se variety of dimensions which may be considered within that specific role. Key

competencies deemed necessary for accomplishing the role are described at the

levels expected by the end of the training and this is followed by a more detailed

description of Specific training requirements within these competencies. Sug-

gestions on appropriate Teaching and Learning as well as Assessment me-

thods for each of the roles competencies are presented. In-depth description of

these methods can be found in the European Board of Rheumatology Educational

Guide.

European rheumatology curriculum MEDICAL EXPERT ROLE


MEDICAL EXPERT/CLINICAL DECISION-MAKER

Definition

As Medical Experts, rheumatologists integrate all of the Roles andcompetencies listed in this document, applying medical knowledge, clinicalskills, and professional attitudes in their provision of patient-centred care.Medical Expert is the central physician role in rheumatology practice.

Description

Rheumatologists possess a defined body of knowledge, clinical skills, proce-dural skills and professional attitudes, which are directed to effective care ofpatients with musculoskeletal conditions. Their care is characterized by up-to-date, ethical, and resource efficient clinical practice as well as by effectivecommunication in partnership with patients, other health care providers andthe community. The Role of Medical Expert is central to the function of rheu-matologists and draws on the competencies included in the Roles of Commu-nicator, Collaborator, Manager, Health Advocate, Scholar and Professional.

Elements

• Core medical knowledge

• In-depth knowledge of musculoskeletal problems and conditions

• Medical history and examination

• Diagnostic reasoning

• Clinical judgment

• Clinical decision-making

• Risk-benefit and pharmaco-economic consideration

• Assessment of the impact of musculoskeletal conditions

• Application of appropriate management

• Procedural skill proficiency

• Team leadership

• Evidence-based practice

• Empathic care

• Integration of all competencies to achieve optimal patient care

•Application of ethical principles for patient care



Key Competencies

By the end of their training a Rheumatologist must be able to…

Demonstrate diagnostic, management and therapeutic skills for ethicaland cost effective patient care in the complete array of musculoskele-tal and connective tissue problems and conditions.

Work in a multiprofessional and multidisciplinary team, recognizing thelimits of their own expertise.

Access, appraise and apply information that is relevant to clinical prac-tice.

Provide efficient support to the development of services related to di-sease prevention, patient care, patient and family education, socialsupport, medical education and legal opinions.

Specific training requirements

To acquire and demonstrate the competencies above, the trainee must exhi-bit, at the completion of training the following specific knowledge, skills andattitudes.

Section A. KNOWLEDGE REQUIREMENTS

A.1. General Knowledge

Upon completion of training, the trainee will be required to demonstrate ope-rational knowledge7 as applied to musculoskeletal conditions, of:

A.1.1 Classification of musculoskeletal conditions

A.1.2 Epidemiological methods in the study of rheumatic disease

A.1.3 Basic statistics for medical sciences

A.1.4 Principles of evidence-based practice

A.1.5 Economic, psychological and social consequences of rheumatic disease

A.1.6 Regulation their local health system, including allocation of resourcesand social policies specific to musculoskeletal conditions

7 Operational knowledge: information at the depth needed for the skilful performance ofall listed competencies, in the perspective of the practising rheumatologist in theirnational setting.



A.2. Basic Sciences

Upon completion of training, the trainee will be required to demonstrate ope-rational knowledge as applied to musculoskeletal conditions, of:

A.2.1 Anatomy and physiology of musculoskeletal tissues, including structureand function of bone, joints, connective tissue, muscle, tendons, nervesand blood vessels, in health.

A.2.2 Immunology, including basic structure and function of central and peri-pheral lymphoid organs, cellular and molecular components of the im-mune system in health and musculoskeletal conditions.

A.2.3 Pathophysiology, as applicable to the understanding of the mechanismsand the treatment of musculoskeletal conditions, including: cellular andmolecular biology, biomechanics, pathophysiology of pain, genetics, im-mune mechanisms (auto-immunity, immune complexes, graft versushost disease), infectious agents, ageing.

A.2.4 Pharmacology, including, among others, basic principles of drugmanagement, pharmacology of agents used in rheumatic disease andtheir interactions with other medications.

A.3. Clinical Sciences

A.3.1. Adult musculoskeletal conditions and problems.

A.3.1.1 Upon completion of training, the trainee will be required to de-monstrate deep and updated knowledge of the musculoskeletalconditions listed at the end.

This will include, for each disease, the epidemiology, genetics, na-tural history, clinical expression including clinical subtypes, patho-logy and disease pathogenesis. The depth of knowledge expectedshall mirror proportionally not only the prevalence but also the po-tential seriousness of each condition in current national rheumato-logy practice.

A.3.1.2 The trainee will be required to demonstrate operational know-ledge of non-musculoskeletal conditions involved in differentialdiagnosis or having implications for the management of musculo-skeletal conditions, such as cardiovascular and renal disease,muscle dystrophies, interstitial lung diseases, diabetes, hyperten-sion, glaucoma, hypercoagulable states, infections, etc.



A.3.2. Paediatric musculoskeletal and connective tissue conditions and pro-blems.

A.3.2.1 In European countries, paediatric rheumatology is a separatemedical specialty, a regulated rheumatology competence or sharedbetween paediatricians and rheumatologists. These recommenda-tions are aimed at the minimum competence for all rheumatolo-gists. Rheumatologists will often be responsible for continued carefor children with musculoskeletal conditions through adolescence toadulthood and must, therefore, be well trained in dealing withadolescents and paediatric diseases persisting into adulthood andtheir sequelae.

Upon completion of training rheumatologists should be able to

A.3.2.2 Assess and formulate a limited differential diagnosis for the con-ditions listed under nº 15 of the list of diseases, including consider-ation of non-musculoskeletal conditions in children that can mimicmusculoskeletal conditions (nº16 of the list of diseases)

A.3.2.3 Know the principles of management of the child with a musculo-skeletal condition and of specific diseases as listed under nº 15 ofthe list of diseases).

A.3.2.4 Describe the natural history of paediatric musculoskeletal condi-tions (nº15 of the list of diseases) and their major complications(nº17 of the list of diseases).

A.3.3 Investigations.

A.3.3.1. At completion of training, the physician should demonstrate fullunderstanding of the biologic rationale, utility, cost, limitations andinterpretation of all investigations used in the regular managementof musculoskeletal conditions and syndromes.

This will include consideration of test-performance characteristics:sensitivity, specificity, and predictive value.

The trainee will have an operational knowledge of the methodsused for such tests.

A.3.3.2. Investigations include:

Laboratory (including specialized immunology tests)

Imaging (Including plain radiographs, computed tomography,magnetic resonance imaging, ultrasonography and radionuclidescanning of bones, joints, and periarticular and vascular struc-tures.)



Measurement techniques using imaging (bone densitometry, quan-titative ultrasound)

Neurophysiology

Capillaroscopy

Arthroscopy

Biopsies

Synovial fluid analysis including polarized light microscopy

A.4. Therapeutics

A.4.1 Indications/contraindications, administration, cost, monitoring andcomplications of all pharmacological agents and techniques, such as in-jections, regularly used in the treatment of musculoskeletal conditionsand syndromes.

A.4.2 Demonstrate operational knowledge of indications, risks and limitationsof physical therapy and rehabilitation, including: exercise (range of mo-tion, strengthening, conditioning, and stretching), rest and splinting,hydrotherapy, spa therapy, joint protection and energy conservationtechniques, adaptive equipment and assistive devices, footwear and or-thotics.

A.4.3 Demonstrate operational knowledge of methods used in the preventionof musculoskeletal conditions including work-related, life-style and nu-tritional issues and patient education.

A.4.4 Appropriate use of and referral to rehabilitation specialists and painclinics.

A.4.5 Demonstrate an understanding of the psychosocial aspects of diseaseand disability and their impact upon the management plan. This will in-clude consideration of psychological and emotional factors, includingsexuality, family and work relationships, vocational issues, costs of the-rapy and monitoring.

A.4.6 Surgical Interventions: for common surgical procedures employed inthe treatment of musculoskeletal conditions, the trainee should demon-strate operational knowledge of indications, preoperative evaluation andmedication adjustments, contraindications, complications, postoperativemanagement and expected outcome.



A.4.7 Complementary Medicine: the trainee should demonstrate operationalknowledge of alternative practices, including diet, nutritional supple-ments, antimicrobials, acupuncture, chiropractic, topicals, homeopathicremedies, venoms and others.

Section B. CLINICAL SKILLS AND PRACTICE REQUIREMENTS

The core clinical skills required from the new rheumatologist include the abili-ty to collect and interpret relevant information about a person with a muscu-loskeletal problem (history, physical examination, laboratory and imagingstudies). They should be able to use it in the light of medical knowledge toperform differential diagnosis, assess the patient’s global status, plan further evaluation and organize and implement a comprehensive management planfor the patient and assess its effect.

This may include children, depending on the circumstances of practice at anational level.

Upon completion of training the trainee will demonstrate the ability to:

B.1. Elicit a history, from patients or relatives, that is relevant, concise, accu-rate and appropriate to the patient's problem(s), including considerationof the patient’s perspective.

B.2. Perform physical examination, including full detailed assessment of themusculoskeletal system, that is appropriate to the patient's problems.

History and physical examination must recognize non-articular manifes-tations, especially those with potential implications in the diagnosisand/or management of musculoskeletal conditions.

B.3. Use, apply and interpret measures of disease activity, functional status,and cumulative damage that are appropriate for the patient’s condition.

B.4. Elaborate an appropriate differential diagnosis and an investigationalplan, which demonstrates a rational and cost-effective use and interpre-tation of relevant investigations.

B.5. Analyze and interpret clinical, laboratory and imaging data derived bythe above processes to establish the most likely diagnosis(es) and acomprehensive assessment of the patient’s status.

B.6. Develop an appropriate management plan based on up-to-date scientificinformation as well as clinical judgment, that accounts for cost and pa-tient preferences and circumstances.



This will include demonstration of the ability to use medications andother therapeutic options, perform patient and family education andsupport, employment of preventive care and incorporation of the ex-pertise of other health professionals.

The new rheumatologist will demonstrate appropriate use of medica-tions under special circumstances like childhood, pregnancy, lactation,renal insufficiency and others.

B.7. Recognize, and appropriately assess and manage emergency rheumato-logical situations, such as scleroderma renal crisis, pulmonary arterialhypertension, atlantoaxial dislocation, catastrophic phospholipids syn-drome and temporal arteritis, among others.

B.8. Design an appropriate follow-up plan including the assessment of re-sponse to treatment, in the knowledge of expectations, and recognitionof adverse events.

B.9. Demonstrate effective, appropriate and timely cooperation with otherhealth professionals as needed for optimal patient care.

B.10. Technical skills8:

Upon completion of training the trainee should be able to routinely and safelyperform without supervision the following technical procedures:

B.9.1. Aspiration of joints and bursae

B.9.2. Injection of joints and soft tissue

B.9.3. Synovial fluid analysis under polarized light

B.9.4. Interpretation of musculoskeletal imaging, bone scintigraphyand bone densitometry

Optional skills

B.9.5. The performance of the following procedures are considered op-tional and may be the object of specific regulation at a nationallevel:

8 The National curriculum should clarify which technical skills are consideredobligatory and at which level of performance they should be demonstrated uponcompletion of training.



Biopsies of relevant tissues and organs (synovium, skin,subcutaneous fat, minor salivary glands, bone, muscle,nerves, kidney, temporal artery, etc.)

Bone densitometryMusculoskeletal ultrasoundCapillaroscopyElectromyographyArthroscopy Injection techniques under imaging guidanceRadioactive or chemical synoviorthesisOther

B.10. Demonstrate effective use of competencies and attitudes listed underthe following chapters in order to convey the highest standards of carefor patients and valuable contributions to the professional developmentof self and others. This includes the ability to

- provide compassionate and humane care;

- work in a multidisciplinary and multiprofessional team.

- provide timely well-documented assessments and recommendations inwritten and/or verbal forms;

- perform disability determination and measurement in the field of socialsecurity disability, workmen’s compensation and other;

- access, retrieve, critically evaluate, and apply information from allsources in maintaining the highest standard of patient evaluation, care,and management;

- show insight into his/her own limitations of expertise by self-assess-ment;

- identify and respond appropriately to ethical issues relevant to rheuma-tology practice;

- demonstrate medical expertise in situations other than those involvingdirect patient care (e.g. medical presentations, teaching, patient andreferring physician education, and medico-legal opinions);

Teaching and Learning Methods

A. Knowledge

Methods and resources for acquiring the recommended body of knowledgeinclude, but are not limited to:



Independent reading - recommended textbooks, journal articles andinternet based research and study

Didactic teaching - conferences, lectures, or discussions

Clinical laboratory experience

Dedicated courses

Clinical rounds

Involvement in teaching

Critical review of literature –journal clubs, etc

B. Clinical skills and practice

Active involvement in patient care, in both the outpatient clinic as well as theinpatient (hospitalized) settings, is the central pillar of skills acquisition.Such experiences must be duly supervised so that the trainee has abundantopportunity to observe skilled clinician role models, participate in themanagement of rheumatologic problems and receive appropriate, construct-ive feedback. Situations in which facets of patient care are taught and learn-ed include:

Didactic teaching - conferences, lectures, or discussions

Clinical experience in a supervised, mentored clinical setting

Interactive case-based discussions

Independent reading - recommended textbooks, journal articlesand internet based research and study

Preparation of patient care portfolios

Clinical case presentations

Web-based case reviews

Assessment Methods

A. Knowledge

Faculty performance rating –with regard to medical knowledge

Evaluation committee

Formal oral or written exam

Mentor evaluation of trainee's clinical performance



B. Clinical skills and practice

Regular formative appraisal and feedback

Faculty performance rating –with regard to patient care

Evaluation committee

Chart review –for patient care, drug prescribing, or outcomes

Presentations to peers and lay audiences

Participation in individual or group quality improvement projects

Formal practical exam

Clinical evaluation exercise (mini-CEX)

Direct observation of practical skills (DOPS)

Objective structured clinical examination (OSCE)

360º evaluations

Portfolio review

Additional information:

1. See the European Board of Rheumatology EDUCATIONAL GUIDE(http://www.uems-rheumatology.net/)

2. Moore DE, Pennington FC, Practice-based learning and improvement, JCont Educ Health Prof, 2003;23:S73-80.

3. Epstein RM, Mindful practice, JAMA, 1999;282:833-9.

4. “Advancing Education in Practice-Based Learning and Improvement.” An educational resource developed by the ACGME to aid program directors inteaching and assessing PBLI located atwww.acgme.org/outcome/implement/complete_PBLIBooklet.pdf

European rheumatology curriculum COMMUNICATOR ROLE


COMMUNICATOR

Definition

As Communicators, rheumatologists effectively facilitate the doctor-patientrelationship and the dynamic exchanges that occur throughout the courseand medical management of what are frequently long-term conditions.

Description

Rheumatologists enable and nurture patient-centered therapeutic communi-cation through shared decision-making and effective dynamic interactionswith patients, families, caregivers, other professionals, and important otherindividuals. The competencies of this role are essential for establishing rap-port and trust, formulating a diagnosis, delivering information, striving formutual understanding, and facilitating a shared plan of care. Confidentialityand ethics must be respected.

The application of these communication competencies and the nature of thedoctor-patient relationship vary for different cultures, conditions and indivi-dual needs for information. The potential barriers of language and cultureneed to be recognized.

Elements

• Patient-centred approach

• Empathy, Concordance, Mutual understanding

• Relational competence in interactions

• Effective listening

• Use of expert verbal and non-verbal communication

•Respect for diversity

• Interactive process

• Eliciting and synthesizing information for patient care

• Attention to the psychosocial aspects of illness

• Conveying effective oral and written information for patient care

• Shared decision-making

• Rapport, trust and ethics in the doctor-patient relationship

• Constructive relationships with patients, families and caregivers



• Capacity for compassion, trustworthiness, integrity

• Flexibility in application of skills

• Efficiency, Accuracy

• Breaking bad news

• Addressing end-of-life issues

• Disclosure of error or adverse event

• Informed consent

• Capacity assessment

• Appropriate documentation

• Public and media communication, where appropriate

Key Competencies


1. Develop a good interaction with empathy, trust and ethical therapeutic re-lationships with patients, carers and families;

2. Accurately elicit, select, document and synthesize relevant information andperspectives of patients and families, colleagues and other professionals;

3. Adequately and understandably convey relevant information and explana-tions to patients and families, colleagues and other professionals;

4. Propose and negotiate a common understanding on issues, problems andplans with patients and families, colleagues and other professionals to devel-op a shared plan of care;

5. Convey accurate and effective oral and written information about a medi-cal problem.



1. Develop a good interaction with empathy, trust and ethical therapeutic re-lationships with patients, carers and families:

1.1. Be a good communicator. Rheumatologists must recognize that thisis a core clinical skill for their practice and strive to master it. Theyshould demonstrate an understanding that effective physician-patient



communication can foster patient satisfaction, physician satisfaction, ad-herence and improved clinical outcomes

1.2. Establish positive therapeutic relationships with patients and theirfamilies that are characterized by mutual understanding, trust, respect,honesty and empathy

1.3. Respect patient confidentiality, privacy and autonomy

1.4. Have good consultation skills and be able to effectively facilitate astructured clinical encounter by listening effectively, and being awareand responsive to nonverbal cues

2. Accurately elicit, select, document and synthesize relevant information andperspectives of patients and families, colleagues and other professionals:

2.1. Gather information about the clinical condition, but also about a pa-tient’s beliefs, concerns, expectations and illness experience

2.2. Select, appraise and document relevant information accurately andin a way that can communicate the information reliably to others

2.3 Seek out and synthesize relevant information from other sources,such as a patient’s family, caregivers and other professionals

3. Adequately and understandably convey relevant information and explana-tions to patients and families, colleagues and other professionals:

3.1. Deliver information to a patient and family, colleagues and otherprofessionals in a humane manner, recognizing their needs and in sucha way that it is understandable, encourages discussion and participationin decision-making and concordance with a plan for management

4. Propose and negotiate a common understanding on issues, problems andplans with patients and families, colleagues and other professionals to devel-op a shared plan of care:

4.1. Effectively identify and explore problems to be addressed from apatient encounter, including the patient’s context, responses, concerns, and preferences

4.2. Respect diversity and difference, including, but not limited to, theimpact of gender, culture and religious beliefs on decision-making

4.3. Encourage discussion, questions, and interaction in any encounters

4.4. Engage patients, families, and relevant health professionals in shar-ed decision-making to develop a plan of care

4.5. Effectively address challenging issues related to communicatingwith and supporting people with long term musculoskeletal conditions



4.6. Effectively address challenging communication issues, such as ob-taining informed consent, delivering bad news, and addressing anger,confusion and misunderstanding

5. Convey accurate and effective oral and written information about a medi-cal problem:

5.1. Maintain clear, accurate, and appropriate records (e.g., written orelectronic) of clinical encounters and plans

5.2. Effectively present verbal reports of clinical encounters and plans

5.3. Prepare reports for employers and agencies

5.4. Understand the critical issues involved in presenting medical infor-mation to the public, to insurers or to the media about a medical issue


Methods and resources that can contribute to the acquisition of these compe-tencies include, but are not limited to:

Experiential learning/Tutorial learning. Working with professionalsthat are examples of good practice and actively adopt a tutorialrole towards the trainee in these domains is probably the most ef-ficient way of promoting these competencies

Group case-based discussions

Role playing

Consultation under supervision / video followed by appraisal

Working with patient organizations and public groups

Patient Partners

Assessment Methods


Assessment of Videotaped encounters

360º assessment

Clinical records review

Clinical reports review




1. See the European Board of Rheumatology EDUCATIONAL GUIDE(http://www.uems-rheumatology.net/)

2. “Interpersonal and Communication Skills.” An educational resourcedeveloped by the ACGME to aid program directors in teaching andassessing interpersonal and communication skills located atwww.acgme.org/outcome/implement/interperComSkills.pdf

3. Burack JH, Irby DM, Carline JD, Root RK, Larson EB, Teachingcompassion and respect. Attending physicians' responses to problematicbehaviors, J Gen Intern Med 1999;14:49-55.

European rheumatology curriculum COLLABORATOR ROLE


COLLABORATOR

Definition

As Collaborators, physicians effectively work within a health and social careteam to achieve optimal patient care.

Description

Rheumatologists work in partnership with others who are appropriately in-volved in the care of individuals or specific groups of patients. Modern health-care teams not only include a multidisciplinary group of professionals workingclosely together at one site, such as a ward team, but also extended teamswith a variety of perspectives and skills, in multiple locations. It is thereforeessential that rheumatologists are able to collaborate effectively with pa-tients, families, and an inter-professional team of expert health professionalsfor the provision of optimal care, education and scholarship.

Elements

• Collaborative care, culture and environment

• Sharing of knowledge and information

• Respect for other physicians and members of the healthcare team

• Respect for diversity

• Team dynamics

• Leadership based on patient needs

• Shared decision making

• Delegation

• Effective teams

• Constructive negotiation

• Conflict resolution, management, and prevention

• Organizational structures that facilitate collaboration

• Understanding roles and responsibilities

• Recognizing one’s own roles and limits

• Effective consultation with respect to collaborative dynamics

• Effective primary care –specialist collaboration

• Collaboration with community agencies



• Communities of practice

• Inter-professional health care

• Multiprofessional health care

• Health insurers

• Learning together

• Gender issues

Key Competencies


1. Participate effectively and appropriately in a multiprofessional and multi-disciplinary healthcare team;

2. Effectively work with other health care providers and agencies to negotiateand resolve issues relevant to patient care;

3. Collaborate with organizations for people with musculoskeletal conditions.



1. Participate effectively and appropriately in a multiprofessional and multi-disciplinary healthcare team:

1.1. Know, understand and respect the roles and responsibilities and dy-namics of other professionals within the multiprofessional and multi-disciplinary healthcare team

1.2. Demonstrate a respectful attitude towards other colleagues andmembers of an interprofessional team

1.3. Work with others to assess, plan, provide and integrate multidis-ciplinary care for individual patients (or groups of patients) recognizingthe broad impact of musculoskeletal conditions on the individual, theircarers and family (WHO ICF)

1.4. Where appropriate, work with others to assess, plan, provide andreview other tasks, such as research problems, educational work, pro-gram review or administrative responsibilities

1.5. Participate effectively in multidisciplinary team meetings



1.6. Respect team ethics, including confidentiality, resource allocationand professionalism, working with other professionals to prevent con-flicts

1.7. Where appropriate, demonstrate leadership in a healthcare team

2. Effectively work with other health care providers and agencies to negotiateand resolve issues relevant to patient care:

2.1. Demonstrate knowledge of regulations and practices related to ac-cess to appropriate care

2.2. Be able to develop a case based on evidence and best practice tofacilitate negotiation

2.3. Employ collaborative negotiation to resolve conflicts

2.4. Respect differences, misunderstandings and limitations in otherprofessionals

2.5. Recognize one’s own differences, misunderstanding and limitations that may contribute to inter-professional tension

2.6. Reflect on inter-professional team function and on his own contribu-tions to its effectiveness

3. Collaborate with organizations for people with musculoskeletal conditions:

3.1. Know of the organizations that support people with various muscu-loskeletal conditions, what they offer for supporting people and of thepotential benefits of successful collaboration with them



Experiential learning in Departments and professionals that areexamples of good practice in these domains


Performance under supervision followed by appraisal

Working with patient organizations and public groups

Assessment Methods


Assessment of encounters



360º assessment

Clinical reports review


1. European Board of Rheumatology EDUCATIONAL GUIDE(http://www.uems-rheumatology.net/)

European rheumatology curriculum MANAGER/LEADER ROLE


MANAGER/MEDICAL LEADER

Definition

As Managers/medical leaders, rheumatologists must be prepared to act asintegral participants in healthcare organizations, organizing sustainable prac-tices, making decisions about allocating resources, and contributing to the ef-fectiveness of the healthcare system.

Description

Rheumatologists interact with their work environment as individuals, asmembers of teams or groups, and as participants in the health system local-ly, regionally or nationally.

Rheumatologists function as Managers of practice activities involving a multi-disciplinary team, resources and organizational tasks, such as care proces-ses, and policies as well as balancing their personal lives.

Thus, rheumatologists require the ability to prioritize, effectively executetasks collaboratively with colleagues, and develop the service whilst makingsystematic choices when allocating scarce healthcare resources.

Elements

• Organization, structure and financing of the healthcare system

• Budgeting and finance

• Priority-setting

• Practice management to maintain a sustainable practice and physi-cian health

• Health human resources

• Administration

• Physician remuneration options

• Negotiation

• Career development

• Information technology for healthcare

• Development of a Rheumatology service

• Quality assurance and improvement

• Leadership



• Supervising others

• Collaborative decision-making

• Effective meetings and committees

• Managing change

• Consideration of justice, efficiency and effectiveness in the allocation of finite healthcare resources for optimal patient care

• Time management

Key Competencies

Rheumatologists must be able to…

1. Participate effectively in activities that contribute to the effectiveness oftheir healthcare organizations and systems;

2. Manage their practice and career effectively;

3. Understand and critically allocate finite healthcare resources appropriatelyin the interest of patients and the community;

4. Serve in administration and leadership roles


These competencies cannot be fully trained and acquired during specialisttraining, but will rather be develop and matured through continuing profes-sional development. Training programmes must, however, set the basic con-ditions to facilitate this process and verify that they have been acquired.

At the completion of training rheumatologists must demonstrate the followingspecific knowledge, skills and attitudes.

1. Participate effectively in activities that contribute to the effectiveness oftheir healthcare organizations and systems:

1.1. Ability to work collaboratively with others in their organizations

1.2. Understand the basis of and support quality process evaluation andimprovement, such as development and implementation of guidelinesand recommendations

1.3. Describe the structure and function of the healthcare system as itrelates to Rheumatology, including the roles of physicians

1.4. Describe principles and discuss main problems of healthcare finan-cing



2. Manage their practice and career effectively:

2.1. Set priorities and manage time to balance patient care, practice re-quirements, outside activities and personal life

2.2. Describe the principles of practice management, including financesand human resources

2.3. Design and discuss processes to ensure service development aswell as personal practice improvement

2.4. Employ information technology appropriately for patient care

3. Understand and critically allocate finite healthcare resources appropriatelyin the interest of patients and the community

3.1. Demonstrate appropriate consideration of cost-effectiveness prin-ciples in patient care

3.2. Recognize the importance of just allocation of healthcare resources,balancing effectiveness, efficiency and access with optimal patient care

3.2. Apply evidence and management processes for cost-appropriatecare

4. Serve in administration and leadership roles, as appropriate:

4.1. Participate effectively in committees and meetings

4.2. Demonstrate appropriate leadership skills when appropriate, includ-ing the supervision of younger trainees

4.3. Demonstrate a good operational understanding of planning and ad-ministration in health care delivery (e.g., work schedules, departmentreports and accounting, etc)



Experiential learning in Departments that are examples of goodpractice in these domains


Dedicated courses on principles of management

Assessment Methods




Portfolios

360º assessment

Performance ratings with regard to each specific competency,following a predefined structured assessment known to all parties.


1. European Board of Rheumatology EDUCATIONAL GUIDE(http://www.uems-rheumatology.net/)

2. Nolan T. Understanding medical systems, Ann Intern Med 1998; 128:293-298.

3. Macones GA, Goldie SJ, Peipert JF: Cost-effective analysis: anintroductory guide for clinicians. Obstet Gynecol Surv 1999; 54:663-672.

4. Systems-based practice: to learn about and improve the system. ACGMEBulletin, November, 2004. www.acgme.org

European rheumatology curriculum HEALTH ADVOCATE ROLE


HEALTH ADVOCATE

Definition

As Health Advocates, rheumatologists responsibly use their expertise and in-fluence to advance the health and well-being of individual patients, communi-ties and populations, especially in respect to musculo-skeletal and connectivetissue conditions.

Description

Rheumatologists recognize and embrace their duty to promote the overallhealth of their patients and the society they serve. They recognize advocacyactivities as important for the individual patient, for populations of patientsand for communities. Individual patients need physicians to assist them innavigating the healthcare system and accessing the appropriate health re-sources in a timely manner. Communities and societies need Rheumatolo-gists’ special expertise in identifying health risks and solutions with respect to the musculoskeletal system as well as their contribution to wise and equit-able allocation of health resources. At this level, health advocacy involves ef-forts to change specific practices or policies on behalf of those served. Healthadvocacy is appropriately expressed both by individual and collective actionsof physicians in influencing public health and policy.

Elements

• Advocacy for individual patients, populations and communities

• Health promotion and disease prevention

• Determinants of health, including psychological, biological, social, cultural,legal and economic

• Individual and socioeconomic burden of the musculoskeletal diseases

• The medical profession’s role in society

• Responsible use of authority and influence

• Mobilizing resources as needed

• Adapting practice, management and education to the needs oftheindividual

• Patient rights to efficient and safe care

• Principles of health policy and its implications



• Interactions of advocacy with other Roles and competencies describ-ed in this document

• Structure and functioning of the health and social security systems

• Allocation of resources in the health and social security systems

Key Competencies

Rheumatologists are able to…

1. Respond to individual patient health needs and issues as part of patientcare;

2. Respond to the health needs of the communities that they serve;

3. Identify the determinants of health of the populations that they serve;

4. Promote the health of individual patients, communities and populations.


These competencies cannot be fully acquired during specialist training, butwill rather be developed and matured through continuing professional devel-opment. Training programmes must, however, set the basic conditions to fa-cilitate this process and verify that they have been acquired.

At the completion of training rheumatologists must be able to demonstratethe following specific knowledge, skills and attitudes.

1. Respond to individual patient health needs and issues as part of patientcare:

1.1. Identify the health needs of an individual patient

1.2. Identify and use opportunities for advocacy, health promotion anddisease prevention with individuals to whom they provide care

1.3. Knowledge of the applicable regulations of health and social securi-ty systems

1.4. Be prepared to provide expert testimony in medico-legal conflictsbetween patients and insurance companies or in malpractice suits.

2. Respond to the health needs of the communities that they serve:

2.1. Describe the relevant social and health aspects of the communitiesthat they serve



2.2. Identify opportunities for advocacy, health promotion and diseaseprevention in the communities that they serve, and respond appro-priately

2.3. Appreciate the possibility of competing interests between the com-munities served and other populations

3. Identify the determinants of health for the populations that they serve:

3.1. Identify the determinants of health of the populations, includingbarriers to access to care and resources

3.2. Identify vulnerable or marginalized populations within those servedand opportunities to improve their condition

4. Promote the health of individual patients, communities, and populations:

4.1. Describe and advocate an approach to implementing a change in adeterminant of health of the populations they serve

4.2. Describe how public policy impacts on the health of the populationsserved

4.3. Identify points of potential personal influence in the healthcare sy-stem and its structure

4.4. Demonstrate a balanced consideration of the ethical and profes-sional issues inherent to health advocacy, including altruism, socialjustice, autonomy, integrity and idealism

4.5. Appreciate the possibility of conflict inherent to their role as ahealth advocate for a patient or community with that of manager orgatekeeper

4.6. Describe the role of the medical profession in advocating collective-ly for health and patient safety



Experiential learning in Departments that are examples of goodpractice in these domains


Dedicated courses on ethics and advocacy

Actual advocacy assignments



Work with patient associations and other groups involved in suchactivities

Assessment Methods

Portfolios

360º assessment

Written reports

Case-based questioning


1. European Board of Rheumatology EDUCATIONAL GUIDE (http://www.uems-rheumatology.net/)

European rheumatology curriculum SCHOLAR ROLE


SCHOLAR

Definition

As Scholars, rheumatologists should demonstrate a lifelong pursuit ofmastering their domain of expertise and engage in the creation, dissemina-tion, application and translation of medical knowledge of their field.

Description

As physicians, through reflective practice, they recognize the need to becommitted to continued learning and to model this for others. Through theirscholarly activities, they contribute to the creation, dissemination, applicationand translation of medical knowledge. They recognize and assume their roleas formal or informal teachers and educators(role-models). In accordance,they facilitate the education of their students, patients, colleagues, healthprofessionals and community.

Elements

• Commitment to lifelong learning, to enhance competence and be ac-countable

• Reflection on all aspects of practice

• Self-assessment

• Accessing and critically appraising evidence, statements and recom-mendations

• Evidence-based medicine

• Principles of teaching and learning

• Role modelling

• Giving feedback

• Mentoring

• Assessing learners

• Teacher-student ethics, power issues, confidentiality, boundaries

• Principles of research / scientific inquiry

• Research ethics, disclosure, conflicts of interests, human subjects and industry relations



Key Competencies

Rheumatologists must be able to…

1. Demonstrate the competencies and attitudes needed to enhance the qua-lity of their professional performance through ongoing learning and self as-sessment;

2. Apply the principles of evidence-based medicine in their practice;

3. Facilitate the learning of patients, families, students, trainees, relevanthealth professionals, the public, and others, as appropriate;

4. Contribute to the creation, dissemination, application, and translation ofnew medical knowledge and practices, especially in the field of rheumatolo-gy;

5. Exercise appropriate interaction with industry and other commercial inter-ests, with due consideration of risks regarding conflicts of interest.


At the completion of training rheumatologists must demonstrate the followingspecific knowledge, skills and attitudes.

1. Demonstrate the competencies and attitudes needed to enhance the quali-ty of their professional performance through ongoing learning and self as-sessment:

1.1. Describe the principles and strategies for developing and imple-menting a personal plan for continuous professional development

1.2. Identify knowledge gaps and learning needs

1.3. Demonstrate methods and results of a personal practice audit

1.4. Pose an appropriate learning question, access and interpret the re-levant evidence

1.5. Integrate new information into practice

1.6. Describe the principles of quality management

2. Apply the principles of evidence-based medicine in their practice:

2.1. Describe the principles of evidence based medicine

2.2. Describe the principles and demonstrate experience in the identifi-cation, retrieval and critical appraisal of evidence (in the framework ofevidence based medicine) in order to address a clinical question



2.3. Integrate critical appraisal conclusion into clinical care, especiallywith respect to risk-benefit ratio

3. Facilitate the learning of patients, families, students, trainees, relevanthealth professionals, the public and others, as appropriate:

3.1. Describe the principles of teaching and learning relevant to medicaleducation

3.2. Collaboratively identify the learning needs and desired learning out-comes of others

3.3. Select effective teaching approaches and content to facilitate thelearning of others

3.4. Demonstrate the ability to effectively communicate and teach mat-ters of rheumatology to other professionals and the public

3.5. Provide effective feedback

3.6. Describe the principles of ethics with respect to teaching

4. Contribute to the development, dissemination, and translation of newknowledge and practices, especially in the field of rheumatology:

4.1. Describe the principles of research and scientific inquiry

4.2. Describe the principles of research ethics

4.3. Elaborate a relevant and appropriate research question

4.4. Conduct a systematic search for existing evidence

4.5. Demonstrate a critical insight regarding appropriate research me-thods to address the question

4.6. Demonstrate knowledge on how to disseminate the findings of astudy



Self-directed learning

- Independent reading - recommended textbooks, journal ar-ticles and internet based research and study

Dedicated courses

- Evidence based medicine,

- Research methodology,



- Audit,

- ‘Teach the Teachers’ courses,

- Other courses

Relevant experience in a supervised, mentored setting

- Faculty-facilitated group discussions and tutorials

- Faculty role modelling

- Interactive case-based discussions

- Participation in individual or group audit and other qualityimprovement projects

- Systematic chart review of their own patients

- Preparation and presentation of patient care portfolios

- Research projects

- Teaching

- Preparation and presentation of EBM reviews

- Presentations to peers and lay audiences

Assessment Methods

Possible evaluation methods for these competencies include,


Portfolios

360º assessment

Performance ratings with regard to each specific competency,following a predefined structured assessment known to all parties.


1. European Board of Rheumatology EDUCATIONAL GUIDE (http://www.uems-rheumatology.net/)

European rheumatology curriculum PROFESSIONAL ROLE


PROFESSIONAL

Definition

As professionals, rheumatologists are committed to the health and well beingof individuals and society through ethical practice, profession-led regulationand high personal standards of behaviour.

Description

Rheumatologists, like all physicians, have a unique role as professionals whoare dedicated to the health and caring of others. Their work requires themastery of a complex body of knowledge and skill, as well as the art of medi-cine. As such, the Professional role is guided by codes of ethics, and a com-mitment to clinical competence, the embracing of appropriate attitudes andbehaviours, integrity, altruism, personal well being, and to the promotion ofthe public good within their domain. These commitments form the basis of asocial contract between the physician and society. Society in return, grantsphysicians the privilege of profession-led regulation with the understandingthat they are accountable to those served.

Elements

• Altruism and empathy

• Integrity and honesty

• Compassion and caring

• Morality and codes of behaviour

• Responsibility to society

• Responsibility to the profession, including obligations of peer review

• Responsibility to self, including personal care in order to serve others

• Commitment to excellence in clinical practice and mastery of the dis-cipline

• Commitment to the promotion of the public good in health care

• Accountability to professional regulatory authorities

• Commitment to professional standards

• Bioethical principles and theories

• Medico-legal frameworks governing practice



• Self-awareness

• Sustainable practice and physician health

• Self-assessment

• Disclosure of error or adverse events

Key Competencies

As Professionals, rheumatologists must …

1. Demonstrate a commitment to their patients, profession, and societythrough ethical practice;

2. Demonstrate a commitment to their patients, profession and societythrough participation in profession-led regulation;

3. Demonstrate a commitment to physician health and sustainable practice.


These competencies will develop and mature through continuing professionaldevelopment. Training programmes must, however, establish the appropriatestandards and reinforce the attitudes that will lead to lifelong commitment tothe principles.

At the completion of training rheumatologists must be able to

1. Demonstrate a commitment to their patients, profession, and societythrough ethical practice:

1.1. Exhibit appropriate professional behaviours in practice, includinghonesty, integrity, commitment, compassion, respect and altruism

1.2. Demonstrate a commitment to delivering the highest quality careand maintenance of competence

1.3. Demonstrate responsiveness to the needs and interests of patientsthat supersedes self-interest.

1.4. Demonstrate the ability to provide autonomy to their patients todecide upon treatment once all treatment options and risks have beenoutlined for them.

1.5. Provide and obtain key elements of informed consent in an under-standable manner for therapeutic interventions and clinical research en-deavours.

1.6. Recognize and appropriately respond to ethical issues encounteredin practice and always be aware of conflicts of interest.



1.7. Appropriately manage conflict of interest, with special focus on rela-tionships with the pharmaceutical industry

1.8. Recognize the principles and limits of patients confidentiality as de-fined by professional practice standards and the law

1.9. Maintain appropriate relations with the patients

2. Demonstrate a commitment to their patients, profession and societythrough participation in profession-led regulation:

2.1. Appreciate the professional, legal and ethical codes of practice

2.2. Fulfil the regulatory and legal obligations required of current prac-tice

2.3. Demonstrate accountability to professional regulatory bodies

2.4. Recognize and respond to other’s unprofessional behaviours in practice

2.5. Participate in peer review and audit

3. Demonstrate a commitment to physician health and sustainable practice:

3.1 Balance personal and professional priorities to ensure personalhealth and sustainable practice

3.2 Strive to heighten personal and professional awareness and insight

3.3 Recognize other professionals in need and respond appropriately


Experiential learning in Departments that are examples of goodpractice in these domains is the most efficient way of promotingthese competencies

Faculty role modelling and mentorship.


Participation in professional activities. Trainees should be giventhe opportunity to participate in community service, professionalorganizations, and institutional committee activities.

Didactic teaching - conferences, lectures, or discussions devotedto topics of professionalism.

Faculty-facilitated group discussions. Case vignettes or journalclub discussions of issues of professionalism that provide the op-portunity for frank discussions between faculty and trainees aboutthese issues.



Independent reading. Reading assignments of peer reviewed pub-lications and specialty organization publications on professional-ism.

Assessment Methods

Faculty performance rating - with regard to demonstration of pro-fessional behaviour

360 evaluations –regarding professional attitudes and behavior.Trainees may also fill out self-evaluations in the sphere of profes-sionalism.

Portfolio review – including reflective entries on issues of profes-sionalism such as difficult patient and peer encounters, conflictsof interest, and barriers to providing equitable care.

Patient survey - with components that specifically addresstrainee’s professionalism.


1. Rothman DJ, Medical professionalism - focusing on the real issues, N EnglJ Med 2000;342:1284-6.

2. Klein EJ, Jackson JC, Kratz L, Marcuse EK, McPhillips HA, Shugerman RP,Watkins S, Stapleton FB, Teaching professionalism to residents, AcadMed. 2003 Jan;78(1):26-34.

3. Hatem CJ. Teaching approaches that reflect and promote professionalism.Acad Med. 2003 Jul;78(7):709-13.

4. ABIM Medical Professionalism in the new millenium: A physician charter.Ann Internal Med 2002; 136‐243‐6.

4. Blank, L., Medical Professionalism in the new millennium; A physiciancharter 15 months later. Ann Internal Medicine 2003; 138;839‐841.

5. Steinert Y, Cruess S, Cruess R, Snell L, Faculty development for teachingand evaluating professionalism: from programme design to curriculumchange, Med Educ. 2005 Feb;39(2):127-36.

6. McCormick BB, Tomlinson G, Brill-Edwards P, Detsky AS, Related Articles,Effect of restricting contact between pharmaceutical companyrepresentatives and internal medicine residents on post-training attitudesand behavior, JAMA. 2001 Oct 24-31;286(16):1994-9.

7. Kuczewski, M., Fostering Professionalism: The Loyola Model. CambridgeQuarterly of Healthcare Ethics, 2003; 12: 161‐166.



8. Branch, W., Feedback and Reflection: Teaching Methods for ClinicalSettings. Academic Medicine 2002; 77: 1185‐1188.

9. Siegler, M., Training Doctors for Professionalism: Lessons Learned fromTeaching Clinical Medical Ethics. Mount Sinai Journal of Medicine, 2002;69: 404‐409.

10. “Advancing Education in Professionalism.” An educational resource developed by the ACGME to aid program directorshttp://www.acgme.org/outcome/implement/Profm_resource.pdf

11. The ACGME also has a comprehensive list of professionalism referencesavailable at http://www.acgme.org/outcome/comp/refProf1.asp

12. The ACGME provides several assessment tools for the evaluation ofprofessionalism: http://www.acgme.org/outcome/assess/profIndex.asp

13. NBME Embedding Professionalism in Medical Education: Assessment as atool for Implementation 2002http://www.nbme.org/PDF/NBME_AAMC_ProfessReport.pdf

14. NBME Behaviors of Professionalism http://ci.nbme.org/professionalism/

15. The American Medical Association Ethics Publication “Virtual Mentor” found at www.virtualmentor.org.

16. American Medical Association. "Embedding Professionalism in MedicalEducation: Assessment as a tool for implementation."http://www.nbme.org/PDF/NBME_AAMC_ProfessReport.pdf

European rheumatology curriculum LIST OF RHEUMATICS CONDITIONS


EUROPEAN RHEUMATOLOGY CURRICULUM FRAMEWORK

List of conditions

1. Rheumatoid Arthritis

2. Seronegative spondyloarthropathies - ankylosing spondylitis, reac-tive arthritis, psoriatic arthritis, inflammatory bowel disease-associatedarthritis, arthritis associated with acne and other skin diseases, SAPHOsyndrome, and undifferentiated spondyloarthritis

3. Lupus erythematosus and Antiphosholipid syndrome- systemic,discoid, and drug-related SLE; Primary and secondary antiphospholipidantibody syndrome

4. Scleroderma - diffuse and limited systemic sclerosis, localized syn-dromes, chemical/drug-related, slerodermiform syndromes

5. Other systemic connective tissue diseases - eosinophilic fasciitis,eosinophilia-myalgia syndrome, Sjögren’s syndrome, polymyositis anddermatomyositis, relapsing polychondritis, relapsing panniculitis,erythema nodosum, adult-onset Still’s disease, overlap syndromes in-cluding mixed connective tissue disease, undifferentiated connective tis-sue disease

6. Vasculitis and related diseases: polyarteritis nodosa, Wegener’s granulomatosis and other ANCA-associated diseases like microscopicpolyarteritis and allergic granulomatosis of Churg-Strauss, temporalarteritis/polymyalgia rheumatica, Takayasu’s arteritis, systemic necro-tizing vasculitis overlaps, Behcet’s disease, hypersensitivity and small vessel vasculitis, cryoglobulinemia, Cogan’s syndrome, central nervous system vasculitis, pseudovasculitis, endangitis obliterans (Buerger’s disease), periaortitis (Ormond’s syndrome), Sweet’ssyndrome.

7. Infectious and reactive arthritis

Infectious/septic arthritis: bacterial (non-gonococcal and gonococcal),mycobacterial, spirochetal (syphilis, Lyme), viral (HIV, hepatitis B,parvovirus, other), fungal, parasitic

Whipple’s disease

Reactive arthritis: acute rheumatic fever, arthritis associated withsubacute bacterial endocarditis, intestinal bypass arthritis, post-dysenteric arthritis, post-immunization arthritis, other colitic-asso-ciated arthropathies



8. Disorders of the locomotor system associated with primarilymetabolic, endocrine or haematological diseases

Crystal-associated diseases: monosodium urate monohydrate (gout),calcium pyrophosphate dihydrate deposition disease, basic calciumphosphate (hydroxyapatite), calcium oxalate

Endocrine-associated diseases: rheumatic syndromes associated withdiabetes mellitus, acromegaly, hyperparathyroidism, hypoparathy-roidism, hyperthyroidism, hypothyroidism, Cushing’s disease

Haematological-associated diseases: rheumatic syndromes associatedwith haemophilia, haemoglobinopathies, angio-immunoblastic lym-phadenopathy, multiple myeloma, Hodgkin- and non-Hodgkin lym-phoma, primary and drug-induced myelodysplastic and myelopro-liferative syndromes.

9. Bone and cartilage disorders

Osteoarthritis: primary and secondary osteoarthritis, chondromalaciapatellae

Metabolic bone disease: osteoporosis, osteomalacia, bone disease re-lated to renal disease

Paget’s disease of bone

Avascular necrosis of bone: idiopathic, secondary causes, osteochon-dritis dissecans

Others: transient osteoporosis, hypertrophic osteoarthropathy, diffuseidiopathic skeletal hyperostosis, insufficiency fractures

10. Hereditary, congenital, and inborn errors of metabolismassociated with rheumatic syndromes

Disorders of connective tissue: Marfan’s syndrome, osteogenesis imperfecta, Ehlers-Danlos syndromes, pseudo-xanthoma elasti-cum, hypermobility syndrome, others

Mucopolysaccharidoses

Osteochondrodysplasias: multiple epiphyseal dysplasia, spondylepi-physeal dysplasia

Inborn errors of metabolism affecting connective tissue: homo-cystinuria, ochronosis

Storage disorders: Gaucher’s disease, Fabry’s disease, Farber’s lipo-granulomatosis

Immunodeficiency: Acquired and hereditary neutropenia, IgA defi-ciency, Common variable immunodeficiency (CVID) and otherforms of hypogammaglobulinemia (e.g. Bruton’s disease, Hyper-IgM syndromes), primary T cell defects (e.g. SCID, ADA and PNPdeficiency), secondary T cell deficiencies (e.g.HIV, low CD4 syn-drome, drug induced),



Autoinflammatory syndromes including familial Mediterranean fever,Muckle-Wells Syndrome, tumor necrosis factor receptor-associatedperiodic syndromes (TRAPS).

Others: haemochromatosis, hyperlipidemic arthropathy, myositis os-sificans progressiva, Wilson’s disease, others

11. Non-articular and regional musculoskeletal disorders

Fibromyalgia

Myofascial pain syndromes

Axial syndromes: low back pain, spinal stenosis, intervertebral discdisease and radiculopathies, cervical pain syndromes, coccydynia,osteitis condensans ilii, osteitis pubis, spondylolisthesis/ spondylo-lysis, infectious and aseptic diskitis

Regional musculoskeletal disorders: in addition to bursitis, tendonitis,or enthesitis occurring around each joint, the trainee should be fa-miliar with other disorders occurring at each specific joint site(e.g., shoulder-rotator cuff tear, adhesive capsulitis, impingementsyndrome; wrist ganglions; trigger fingers and Dupuytren’s con-tractures; knee synovial plicaes, internal derangements, cysts; hal-lux rigidus, heel pain, and metatarsalgia; TMJ syndromes; costo-chondritis.

Biomechanical/anatomic abnormalities associated with regional painsyndromes: scoliosis and kyphosis, leg length discrepancy, foot de-formities

Overuse rheumatic syndromes: occupational, sports, recreational,performing artists

Sports medicine: injuries, strains, sprains, nutrition, female athlete,medication issues

Entrapment neuropathies: thoracic outlet syndrome, upper extremityentrapments, lower extremity entrapments

Other: reflex sympathetic dystrophy, erythromelalgia

12. Neoplasms and tumor-like lesions

Benign:

i. Joints: loose bodies, fatty and vascular lesions, synovialosteochondromatosis, pigmented villonodular synovitis, gang-lions

ii. Tendon sheaths: fibroma, giant cell tumor, nodular tenosyno-vitis

iii.Bone: osteoid osteoma, others

Malignant:

iv.Primary: synovial sarcoma, others



v. Secondary: leukaemia, myeloma, metastatic malignant tu-mours

vi.Malignancy-associated rheumatic syndromes: carcinomatouspolyarthritis, palmo-plantar fasciitis

13. Muscle diseases

Inflammatory - polymyositis, dermatomyositis, inclusion body myosi-tis

Metabolic:

i. Primary: glycogen storage diseases, lipid metabolic dis-orders, myoadenylate deaminase deficiency, mitochondrialmyopathies

ii. Secondary: nutritional, toxic, endocrine disorders, electrolytedisorders, drug-induced

Muscular dystrophies

Myasthenia gravis

14. Miscellaneous rheumatic disorders

Amyloidosis: primary, secondary, hereditary

Raynaud’s disease

Charcot joint

Remitting seronegative symmetrical synovitis with pitting edema

Multicentric reticulohistiocytosis

Plant thorn synovitis

Intermittent arthritis: palindromic rheumatism, intermittenthydrarthrosis

Arthritic and rheumatic syndromes associated with: sarcoidosis,scurvy, pancreatic disease, chronic active hepatitis, primary biliarycirrhosis, drugs, vaccinations and environmental agents

Rheumatic disease in the geriatric population

Rheumatic disease in the pregnant patient

Rheumatic syndromes in renal insufficiency and dialysis patients

Uveitis and scleritis

15. Paediatric musculoskeletal conditions (Ability to diagnose thefollowing musculoskeletal conditions that occur primarily in children, andknow how they differ from the same, or similar, disease in adults. Knowthe treatment of these conditions)

Systemic juvenile rheumatoid arthritis (Still’s Disease)

Pauciarticular juvenile rheumatoid arthritis



Polyarticular juvenile rheumatoid arthritis

Juvenile spondyloarthropathy

Systemic lupus erythematosus

Scleroderma syndromes

Juvenile dermatomyositis

Kawasaki Disease

Henoch-Shönlein Purpura

Acute rheumatic fever

Neonatal lupus syndrome

16. Recognize non-rheumatic disorders in children that can mimicmusculoskeletal conditions:

Infectious or post-infectious syndromes

i. Septic arthritis and osteomyelitis

ii. Transient synovitis of the hip

iii. Post-infectious arthritis and arthralgia

iv.Post-viral myositis

Orthopaedic conditions

i. Legg-Calve-Perthes Disease and other avascular necrosissyndromes

ii. Slipped capital femoral epiphysis

iii. Spondylolysis and spondylolisthesis

iv.Patello-femoral syndrome

Non-rheumatic pain

i. Benign limb pains of childhood (“growing pains”)

ii. Benign hypermobility syndrome

iii. Pain amplification syndromes including reflex sympatheticdystrophy

Neoplasms

i. Leukaemia

ii. Lymphoma

iii.Primary bone tumours (especially osteosarcoma and Ewing’s sarcoma)

iv.Tumours metastatic to bone (especially neuroblastoma)

Bone and cartilage dysplasias, and inherited disorders of metabolism



17. Know the major sequelae and complications of paediatric mus-culoskeletal conditions and their implications in adult life:

Systemic onset JRA

i. Macrophage activation syndrome

ii. Cardiac tamponade

Pauciarticular JRA

iii. Chronic uveitis

Juvenile dermatomyositis

i. GI vasculitis

ii. Calcinosis

Kawasaki Disease

i. Aneurysms of coronary and other arteries

Henoch-Schonlein Purpura

i. GI- intussusception, intestinal infarction

ii. Renal - chronic nephritis

Neonatal lupus syndrome

i. Congenital heart block

ii. Thrombocytopenia

End

the european rheumatology curriculum ......european rheumatology curriculum final version. 31st...

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